ICE-T: Iron Clinical Evaluation Tool - a Digital Platform for Guideline-Based Iron Study Interpretation and Treatment Recommendations

Introduction

Clinical assessment of a patient's iron status is a competency expected of all internal medicine clinicians in both the inpatient and outpatient setting. However, interpretation of iron panel laboratory studies can be complicated by discordance in diagnosis-specific and society-specific guidelines across the American Society of Hematology, Heart Failure Society of America, Kidney Disease Improving Global Outcomes, American College of Obstetrics and Gynecology, European Society of Cardiology, European Respiratory Society, Crohn's and Colitis Foundation, American Society for Metabolic and Bariatric Surgery. To address this practice gap, we developed a clinical decision support tool to help clinicians interpret iron studies in the context of each patient's unique clinical characteristics. Iron Clinical Evaluation Tool (ICE-T) is an interactive, guideline-based digital educational tool that incorporates patient characteristics and iron studies to provide both interpretation of iron studies as well as treatment recommendations based on strongest available current evidence.

Methods

We conducted an extensive literature review to identify guidelines and professional society recommendations regarding the definition and treatment of iron deficiency (ID) and iron deficiency anemia (IDA) in heart failure, chronic kidney disease, inflammatory bowel disease, celiac disease, history of bariatric surgery, heavy menstrual bleeding, hereditary hemochromatosis, hereditary hemorrhagic telangiectasia, pulmonary arterial hypertension, and malignancy. We translated the recommendations from each society into Boolean logic tables. Programming in R/Shiny, we developed an interactive visual interface that invites users to input de-identified patient data such as age, sex, weight, key lab values, and the aforementioned disease states. Key lab values include hemoglobin, mean corpuscular volume, reticulocytes, ferritin, transferrin, transferrin saturation, and iron levels. Using an original algorithm developed by our team, ICE-T provides interpretation and treatment guidelines based on the inputted lab values and co-existing disease states. ICE-T provides citations for every recommendation as well as the level of evidence supporting each recommendation. ICE-T further offers educational modules for clinicians to learn about the various formulations of oral and intravenous iron supplementation.

Conclusions

To our knowledge, ICE-T is the first clinician-facing digital tool for guideline-based iron study interpretation and treatment recommendations for ID and IDA. With professional societies providing varying diagnosis-specific cutoffs to define and treat IDA, ICE-T is the first tool to integrate cross-guidelines into a unified framework. Future work will involve assessing the effectiveness of the educational tool in clinician focus groups. We hope that ICE-T will improve clinicians' confidence in interpreting iron studies and treating IDA within the context of each patient's unique clinical situation.

No relevant conflicts of interest to declare.